POS0705 PEDIATRIC-ONSET TAKAYASU ARTERITIS ASSOCIATES WITH WORSE SURVIVAL THAN ADULT-ONSET TAKAYASU ARTERITIS – DATA FROM A SINGLE-CENTER MATCHED RETROSPECTIVE COHORT STUDY OF 191 PATIENTS
Authors: D. P. Misra, D. Thakare, P. Mishra, U. Rathore, K. Singh, M. Behera, N. Jain, M. Ora, D. Bhadauria, S. Gamhbir, S. Kumar, V. Agarwal
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> A subset of Takayasu arteritis (TAK) begins in the pediatric age group (≤18 years). Differences in prognosis between pediatric-onset and adult-onset TAK are unclear. <h3>Objectives</h3> To compare the presentation and prognosis between pediatric-onset and adult-onset TAK. <h3>Methods</h3> The clinical presentation, angiographic features, treatment patterns, disease activity on follow-up, and survival were compared between pediatric-onset and adult-onset TAK. Categorical variables were compared using odds ratios (OR between pediatric-onset and adult-onset TAK, with 95% confidence intervals). Survival for pediatric-onset and adult-onset TAK were presented using Kaplan-Meier plots and compared using log-rank test. Hazards ratios (HR, with 95% confidence intervals) were calculated, both crude and adjusted for prognostic factors. Propensity-score matched analyses adjusted for prognostic factors were conducted to assess adjusted differences in survival between pediatric-onset and adult-onset TAK. A previous meta-analysis of the risk of mortality with pediatric-onset vs adult-onset TAK [1] was updated with the findings from this study. The study was approved by the institutional ethics committee., which waived the requirement for informed consent in view of the retrospective review of chart records. <h3>Results</h3> Heart failure [odds ratio (OR) for pediatric-onset vs adult-onset TAK 2.76, 95%CI 1.12–6.80] and chest pain (OR 3.03, 95%CI 1.11-8.34) were more common in pediatric-onset TAK, and stroke or transient ischemic attack was more frequent in adult-onset TAK (OR 0.31, 95%CI 0.10-0.93). Hata's angiographic type V (OR 1.95, 95%CI 1.00-3.78) was commoner in pediatric-onset TAK, as opposed to Hata's type I in adult-onset TAK (OR 0.18, 95%CI 0.04-0.79). Disease activity at baseline, 6, 12, and 24 months, the use of glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) were similar between pediatric-onset and adult-onset TAK. The unadjusted hazard ratio for mortality with pediatric-onset versus adult-onset TAK was 6.13 (95%CI 1.51-24.91), and after adjustment for prognostic covariates (gender, delay to diagnosis, baseline disease activity, number of conventional and biologic/targeted synthetic DMARDs used), was 4.97 (95%CI 1.20-20.58) (Table 1). Survival was worse for pediatric-onset than adult-onset TAK on unadjusted analyses (Figure 1) and after propensity score matching for these covariates (54 pairs, log rank p value 0.026). Risk ratio for mortality with pediatric-onset vs adult-onset TAK across studies was 2.27 (95%CI 1.05-4.85) after updating a meta-analysis of four observational studies [1] by including the present study. <h3>Conclusion</h3> Pediatric-onset TAK associates with greater mortality than adult-onset TAK. Greater vigilance is required while managing pediatric-onset TAK. <h3>Reference</h3> [1]Misra DP, Rathore U, Kopp CR, Patro P, Agarwal V, Sharma A. Presentation and clinical course of pediatric-onset versus adult-onset Takayasu arteritis-a systematic review and meta-analysis. Clin Rheumatol 2022. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.